Healthcare Provider Details

I. General information

NPI: 1053367029
Provider Name (Legal Business Name): STEVEN LLEWELLYN POISSANT PT.,L., AC.,C.S.C.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 06/20/2022
Certification Date: 06/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 N MILL ST
FERTILE MN
56540-4328
US

IV. Provider business mailing address

208 N MILL ST
FERTILE MN
56540-4328
US

V. Phone/Fax

Practice location:
  • Phone: 218-945-3409
  • Fax: 218-945-3588
Mailing address:
  • Phone: 218-945-3409
  • Fax: 218-945-3588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1080
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3093
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: